By Yen Duong

Clarification: This article incorrectly stated that Mecklenburg’s McP unit is the first behavioral health unit in a county jail. Durham County opened a mental health pod in September 2017 for detainees who are too acutely mentally ill for the general population, including those on suicide watch, said Chief Anthony Prignano of the Durham County Sheriff’s Office. The Durham pod employs its own mental health clinicians and a part-time psychiatrist who determine who enters the pod. This article and title has been corrected to show that McP is the first such voluntary unit.

The bottom half of a small basketball court is covered by cheerful yellow paint and speckled with marker doodles of smiling stick figures, flowers and sets of two humps to indicate birds in a sunny sky. That yellow matches stripes on the linoleum floor in the main area set off by columns in cheerful pastels. Numbered doors with small windows lead to residents’ small rooms.

The jail psychiatric unit in downtown Charlotte — known as “McP” — looks like a school, but it’s actually North Carolina’s first voluntary behavioral health unit located in a county jail. Inmates, or residents as the sheriff calls them, take daily medications, attend group classes, and participate in therapy with the aim of getting better before returning to the general population in the Mecklenburg County Central Detention Center or being released to the outside world.

A large reception-looking area with a checkerboard linoleum floor and what looks like a receptionist desk
The main area of the jail psychiatric unit, with one guard stand in the middle and plenty of space for lounging, watching TV, playing games or doing yoga. In addition to the cell doors seen here, a bathroom area, workout space and a group therapy room complete the unit. Photo credit: Yen Duong Credit: Yen Duong

 “I feel [being in jail] can cause mental issues because you can’t just come and go as you please anymore,” said guard Melissa Russell, clad in a gray polo with a “Behavioral Health” logo rather than the usual police uniform.  “This program is designed to help them work through their issues… It’s to show them different ways to process what they’re feeling and what they’re going through.”

‘What we should’ve been doing the whole time’

The voluntary program, which opened in August, has space for 28 male residents. Right now, six men, each diagnosed with a mental illness by a counselor upon intake, take part in the program, which is quiet and separated from the rest of the jail.

 “One of our goals was to make sure that they’re good to be able to function in a normal pod in another unit,” said Sgt. Charles Pearson, the “P” in “McP.” “Some of them… they can’t function in another pod, they can’t be around a lot of people, they can’t follow orders. They end up in our segregation unit, and we don’t want that.”

Segregation (often referred to as solitary confinement) is exactly the opposite of what inmates with mental health issues need, said Luke Woollard, an attorney with the legal advocacy group Disability Rights North Carolina.

“These folks with mental illness end up isolated … which often causes them to get worse because they’re not given any other care,” Woollard said. “[They need] the ability to get out of cells, access trained professionals like psychologists and psychiatrists [and] access medications they’ve been prescribed.”

To join the jail psychiatric unit, residents must participate in a full day of classes during the week, take their medications, and be non-violent. Behavioral health counselors are contracted from a Tennessee-based company that provides staffing for correctional facilities and rehabilitation centers.

A piece of paper with a daily schedule on it, title is "Schedule for Mental Health Pod" This is a schedule that patients in the jail psych unit might use.
During the day, residents of the Mecklenburg jail psychiatric unit have a packed schedule of activities and exercises in the main area. They return to their cells for sleep. Photo credit: Yen Duong Credit: Yen Duong

Pearson said they want to get a federally approved methadone treatment program running in the unit by the end of the year. Methadone is one of three drugs used for medication-assisted treatment, or MAT, to treat opioid use disorder. Residents from the general population would also visit the unit for MAT treatment.

Read more about Medication-Assisted Treatment: Forty-one N.C. counties classified as “high risk” in new opioid study

Mecklenburg County Sheriff Garry McFadden said he put together the unit without additional funding after chatting with Pearson, modeling it after a similar unit in Nashville, Tenn. He’s looking forward to buying cozy, high backed chairs for a “living room” effect and to finding funds to open a women’s unit next year.

“We want to be almost a community,” said McFadden, the “Mc” in “McP,” about their goals for the unit. “For me, I think it’s what we should’ve been doing the whole time.”

“When people say ‘Why are you doing this?’ [I respond] ‘I’m preparing your neighbor,’” McFadden continued. 

Per the U.S. Department of Justice, 95 percent of people who enter prison eventually return to their communities.

“It’s helping our citizens, we want to return them back… we want to return that citizen back better.”

Suicide prevention and mental health care in jails

A 2017 Disability Rights North Carolina report noted that North Carolina jail suicide rates are higher than the national average: nearly 46 percent of NC jail deaths are from suicide versus 35 percent of US jail deaths in 2014.

“We see failures happening a decent amount of time in these suicide cases: failures of observation, failures to recognize that somebody is suicidal… failure to get medication that folks are already prescribed but don’t have with them when they’re arrested,” Woollard, the DRNC attorney, said. “We’re seeing a lot of these issues that continue to be major problems with the mental health care that’s given in jail.”

Inmates are at a particularly high risk of dying of suicide within the first 24 to 72 hours of getting arrested, said Atrium Health forensic psychiatrist Dr. Sherif Soliman.

“In addition to the stress of being booked in jail and facing criminal charges, many are coping with untreated mental health symptoms, such as hallucinations or severe depression,” Soliman said. “Many are suffering the effects of drug withdrawal over these first few days, and in fact, some substance withdrawals, such as alcohol withdrawal, can be fatal.”

Eleven counties reported that over 30 percent of their populations had self-reported mental illnesses upon intake, with Caldwell County reporting 80 percent.

Mecklenburg is one of 47 North Carolina counties to issue a “Stepping Up Resolution” as part of a national initiative, run by several organizations including the American Psychiatric Association, to reduce the number of adults with mental illnesses in local jails. Per the Stepping Up website, people with serious mental illnesses are booked into county jails almost 2 million times a year.

To reduce the amount of time people with mental illnesses spend in jail, Stepping Up counties collect data and run programs such as peer counseling, mental health screenings and crisis intervention training for police and correctional officers. CIT 40-hour training programs teach law enforcement and other first responders, behavioral health staff and advocates how to react to mental health crises.

“What we see common with law enforcement, when you see a person on the street who’s going through a crisis or episode, people are telling him to ‘Get down, drop this, get up,’” McFadden said. “But then you have three or four people talking to this person at the same time. Are you really knowing what you’re doing?… We take training to say how to prevent the crisis [from] escalating.”

Stepping Up training

In Mecklenburg, about 400 of over 1,300 officers are certified in CIT, Pearson said, with a goal of all guards completing CIT and behavioral health training.

Pearson said by next year, the county will open a separate diversion building to treat people with mental illnesses who are booked for lower-level offenses such as loitering or trespassing. He gave examples of a “bag lady” who would not leave a store, or a homeless person camped out on church steps for weeks. Last year, Alamance County received $1.2 million in funding to open such a diversion program, which will be ready next year.

“Some [Stepping Up programs] are making a difference with such things as putting peer support inside the jail to help people, diversion and reentry support, more medical care and treatment,” said Susan Pollitt, an attorney with Disability Rights NC. “All of these things are necessary in North Carolina because unfortunately, we have a problem with people dying in our jails and our regulations and our funding are not adequate to ensure that people are safe when they come into our county jail.”

North Carolina laws do not require jails to run standardized mental health screenings, report suicide attempts nor run suicide prevention programs. Pollitt said those rules are “outdated,” but the Department of Health and Human Services website has a draft of new regulations which include mandatory suicide prevention plans.

But the new rules are stalled in the state’s sometimes Byzantine process for approving new administrative procedures. The new rules have been opposed by the North Carolina Sheriffs’ Association, which wrote in March that a number of the changes “exceed the authority” of the Division of Health Service Regulation, part of DHHS. So the rules have been sent back to the legislature for consideration. 

What comes after jail

Jail is a temporary place: McFadden said his team is looking for community resources to connect with people who are released and hope for eventual changes for the transition from jail to prison. Currently, the state assesses prisoners’ mental health at intake to the state prison system.

A man in a vest and bow tie smiles at the camera between two smiling women in gray polos who are armed. The man is Mecklenburg County Sheriff Garry McFadden, and the two guards work at the jail psych unit.
Mecklenburg County Sheriff Garry McFadden, center, smiles with two specially trained jail psychiatric unit guards. Photo credit: Yen Duong. Credit: Yen Duong

“Mecklenburg can give recommendations, but the state doesn’t have to listen to them,” Pearson said.

“[That] is difficult, because then obviously he’s back to either being treated or not being treated,” McFadden added. “We hope that one day … it could be a step program.”

For people who are released back to the public, McFadden and Pearson hope that keeping up with mental health resources and community resources will reduce recidivism.

“They’re here to get the help that we’re going to provide,” Russell, the jail psychiatric unit guard, said. “[We] give them the tools they need to go out there and succeed. We don’t want them to come back. We don’t need no repeat offenders.”

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Yen Duong covers health care in Charlotte and the southern Piedmont for North Carolina Health News.